APHL 2019 POSTER ABSTRACTS
reveal new clusters of potentially related cases. Optimizing culture-
independent enrichment yielded up to 90% B. pertussis sequencing
read data and significantly reduced host contamination, sufficient
for wgMLST directly from clinical specimens and comparison to
cultured isolates.
These results illustrate the utility of wgMLST for improving B.
pertussis characterization and the addition of culture-independent
enrichment has the potential to increase case representation,
together aiding molecular epidemiology and genomic study of the
current pertussis disease resurgence.
Presenter: Michael Weigand, Centers for Disease Control and
Prevention, Atlanta, GA, [email protected]
Adoption and Adaptation: A Public Health Laboratory’s
Experience Implementing Carbapenem Resistance
Mechanism Surveillance
S. Matzinger, K. Johnson, L. McCoy, S.E. Totten and E. Travanty,
Colorado Department of Public Health and Environment
In recent years, infections caused by Carbapenem-resistant
organisms (CROs) has become a significant public health issue
worldwide. The increase in observed resistance is linked to the
expression of an ever-increasing number of enzymes capable
of degrading this class of broad-spectrum antibiotic drugs. In
response to this concern, Colorado Department of Public Health
and Environment (CDPHE) Laboratory implemented the Antibiotic
Resistance Laboratory Network (ARLN) surveillance algorithms
recommended for detection of Carbapenem resistance mechanisms
in gram negative bacteria and adopted these testing schemes to the
particular needs of our state. In recent years, CDPHE has identified
multiple areas for improvement in our testing scheme that have
resulted in an overall increase in efficiency, as well as an expansion
in mechanism detection capabilities. Specific improvements evolved
from a need to test an ever-growing number of isolates possibly
harboring an increasing range of known resistance mechanisms.
CDPHE performed process improvement by blending the capabilities
of multiple molecular detection assays in order to survey for as
many known mechanisms as possible. In addition, we performed
method extensions for MALDI-TOF isolate identification of CROs in
order to enhance robustness, increase overall testing capacity, and
decrease turnaround times. This poster will describe the specific
CDPHE laboratory derived policies developed in response to the
growing concern of Carbapenem resistance mechanism emergence
and expansion.
in the state and to also raise awareness among members of the
public. Positive rabies virus samples almost doubled from 162 in
2017 to 280 in 2018. During the first half of 2018, the Colorado
Department of Public Health and Environment (CDPHE) Laboratory
Services Division received a total of 169 skunks from Denver and
El Paso counties, of which 81% were positive for rabies. Denver
and El Paso counties also had 80% of the total rabies positive
skunks for the entire state of Colorado. Once it was realized that
both Denver and El Paso counties were having epizootics of rabies
in local skunk populations, it was evident that there was a need to
develop a “right sizing” plan. This volume of testing simply could
not be supported by the budget or personnel available. The goals
of the initial surveillance had already been accomplished, therefore
fee-waived testing was limited to cases of public health importance
(a known exposure or an animal found in a public area). The second
half of 2018 saw a reduction from 169 to just 14 skunks submitted
for testing (10 of which were positive for rabies). This allowed us to
focus our limited resources and trained personnel on the other 860
samples submitted for rabies testing from other areas of Colorado
which do not have epizootics of rabies. Rabies is a part of Colorado,
and as positive rabies virus samples continue to increase, balancing
right sizing with testing capacity will allow us to provide adequate
rabies testing services as we head into 2019.
Presenter: Ryan Bagg, Colorado Department of Public Health and
Environment, Denver, CO, [email protected]
Impact of Nontuberculous Mycobacterium Changing
Guidance on Public Health: A Laboratory Perspective and
Preparedness Plan
S.E. Totten, K. Xavier, H. Webber, T. Regan, E. Travanty and S.
Matzinger, Colorado Department of Public Health and Environment
In 2015, only 5 jurisdictions required Nontuberculous
Mycobacterium (NTM) notifications in a public health setting. In
2016 that number had increased to 11 jurisdictions. Little change
has occurred since 2016 despite increased reporting of NTM
presence within exposures and the environment.
R. Bagg, B. Steidley, K. Mayo, J. Knutsen, S.E. Totten, E. Travanty and
J. House, Colorado Department of Public Health and Environment In 2019, Colorado requested notification of all NTMs through
a Board of Health proposal. This created several public health
laboratory challenges. Public Health has always needed to answer
the question “TB or Not TB” and has had guidance on further
activities if a specimen/isolate was identified as TB. All samples
that were deemed “Not TB” were no longer of public health
concern. Public Health laboratories are often set up to perform
TB determination based on CIDT and then only culture if the
specimen is TB for antimicrobial susceptibility testing (AST). With
report requirements, not just public health laboratories but also
clinical laboratory colleagues will need to become proficient in
NTM cultivation and identification. Our goal is to provide low cost
identification of NTM for our stakeholders that do not currently
support NTM identification. This poster represents our road to
expertise.
As one of the deadliest viruses on Earth, any amount of rabies is
too much. Unfortunately, in Colorado we do not have a say in the
matter. Prior to the 2018 rabies season, Colorado had policy in
place to use the Colorado General Fund to waive rabies testing fees
on rabies reservoir species that were submitted for surveillance
purposes (no known human or animal exposures). This was done to
provide improved data showing where terrestrial rabies had spread Our first step on this journey was to enhance our practice to ensure
optimal recovery. We started with the gold standard methodology for
Acid Fast Bacilli (AFB) specimen isolation including 3 media types:
broth, LJ slants and 7H11 bi-plates. Depending on the specimen
type, additional 7H11 bi-plates may be added for incubation at
320C, RT and 420C. Media will be incubated for 42 days minimum
and up to 8 weeks for LJ slants.
Presenter: Shannon Matzinger, Colorado Dept. of Public Health
and Environment, Denver, CO, [email protected]
How Much Rabies Is Too Much Rabies?
PublicHealthLabs
@APHL
APHL.org
Summer 2019 LAB MATTERS
61